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Question category: Gastroenterology

A 26 year old female presents with fatigue, myalgia and pruritus. She is complaining of vague right upper quadrant pain and has noticed her skin and eyes appearing yellow in colour. On examination there is evidence of hepatomegaly and jaundice. Bloods reveal deranged LFTs (predominantly raised aminotransferases), a normocytic anaemia, elevated IgGs and anti LKM antibodies. Given the most likely diagnosis steroids are commenced however the patient is concerned regarding the side effects of steroids. What agent is used first line as a steroid sparing agent?

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